氣喘病患者罹患骨質疏鬆性骨折的風險 與相關風險因子:  以台灣全人口基礎的前瞻式世代研究

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姓名

周柏良(Po-Liang Chou) 查詢紙本館藏

畢業系所

資訊工程學系在職專班

論文名稱

氣喘病患者罹患骨質疏鬆性骨折的風險與相關風險因子: 以台灣全人口基礎的前瞻式世代研究
(Risk of Osteoporotic Fractures in Patients with Asthma: A Population-based Perspective Cohort Study in Taiwanese People)

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摘要(中)

哮喘是一種常見的肺部疾病，其特點具有慢性發炎，氣流阻塞和支氣管過度反應性。有研究報告指出，慢性炎症可能導致細胞激素(免疫反應)的產生，進而刺激骨再吸收與形成導致增加骨折風險。然而，在氣喘中骨質疏鬆性骨折的發病機制目前還不清楚。目前，類固醇是治療哮喘的最有效的抗發炎藥物。當病患服用低劑量的吸入式類固醇控制不良時，則必須增加吸入式類固醇的劑量或者再加入長效支氣管擴張劑或全身性類固醇。因此，類固醇治療用於氣喘治療和骨質疏鬆性骨折之間扮演一個重要的關鍵因素。因此我們從全民健康保險研究資料庫抓取50歲以上的新發氣喘病患，再來排除一些會影響我們研究的病患，然後評估氣喘以及共病是否會影響得到骨質疏鬆性骨折的風險。最後，我們觀察到使用類固醇治療的氣喘病患，如使用吸入式類固醇加長效支氣管擴張劑的群組與使用全身性類固醇的群組，與那些沒有使用任何類固醇治療的病患有顯著增加骨質疏鬆性骨的風險。其風險分別為，吸入式類固醇加長效支氣管擴張劑 (HR=5.82, 95% CI=1.31-25.86, p-value=0.0205), 全身性類固醇 (HR=3.24, 95% CI=1.23-8.55, p-value=0.0174)。

摘要(英)

Asthma is a common pulmonary disorder, which is characterized by chronic inflammation, airflow obstruction and bronchial hyperresponsiveness. Some study has reported that the chronic inflammation may leads to the production of cytokines, stimulating bone turnover and increased fracture risk. However, mechanisms of osteoporotic fracture in asthma disease is unclear. Currently, corticosteroids is the most effective anti-inflammatory drug for patients with asthma. When patients do not control asthma well with the low-dose ICS, they have to either increase the dosage of ICS or add the long-acting ß-agonist (LABA) or systemic corticosteroids controller medication .Thus, corticosteroids treatment is acts as an intermediary between asthma and the osteoporotic fracture, it is an important key factor. Therefore, we explore over 50 years old newly asthma patients from National Health Insurance Research Database (NHIRD), exclude some patients who affect our study and evaluate the effects of comorbidities with asthma on the osteoporotic fracture risk. Finally, we observe that patients with asthma who take the corticosteroids treatment such as ICS+LABA used group and SCS used group compared with who not use any corticosteroids, there is increase risk of osteoporotic fracture on asthma patients (HR=5.82, 95% CI=1.31-25.86, p-value=0.0205), (HR=3.24, 95% CI=1.23-8.55, p-value=0.0174) respectively.

關鍵字(中)

★ 台灣健保資料庫
★ 氣喘
★ 骨鬆性骨折

關鍵字(英)

★ HNIRD
★ Asthma
★ Osteoporotic Fractures

論文目次

中文摘要 i
ABSTRACT ii
Table of Contents iv
List of Figures vi
List of Tables vii
Chapter 1 Introduction 1
1.1 Background 1
1.2 Motivation 2
1.3 Research Goal 2
Chapter 2 Related Works 3
2.1 Asthma 3
2.2 Obstructive Airway Disease and Osteoporotic fracture 3
Chapter 3 Materials and Methods 5
3.1 Data Source 5
3.2 Study Design and Cohort Selection 5
3.3 Definition of Disease 7
Asthma 7
Osteoporotic Fractures 7
3.4 Confounding Factors 8
3.5 Statistical Analysis 9
Chapter 4 Results 10
4.1 Demographic Characteristics 10
4.2 Incidence Rate and Risk of Asthma between Two Cohorts 12
4.3 Relative Risk of Osteoporotic Fracture among Asthma Cohorts 13
4.4 Medication Treatment Effects 17
4.4.1 Study Cohorts Selection 17
4.4.2 Incidence Rate and Risk of Osteoporotic Fracture 18
4.5 Kaplan-Meier Osteoporotic Fracture -Free Curves 19
Chapter 5 Discussion 21
Chapter 6 Conclusion 24
References 25

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指導教授

洪炯宗(Jorng-Tzong Horng)

審核日期

2016-7-22

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